Perioperative cardiovascular risk evaluation using FFR-CT in patients with peripheral arterial occlusive disease

Ievads. Perifēro artēriju okluzīva slimība (PAOS) ir aterosklerotiska saslimšana, kas raksturojas ar vienas vai vairāku perifēro artēriju stenozi vai oklūziju. Kopīgie riska faktori PAOS un koronāro artēriju slimībai (KAS) rezultējas ar to, ka pacientiem ar PAOS ir lielāka KAS incidence, kā arī risks jauniem koronāriem notikumiem. PAOS pacientu mirstība koronāro notikumu dēļ ir 6,6 reizes lielāka nekā pacientiem bez šīs slimības (Duran et al., 2010). Frakcionētās plūsmas rezerves aprēķināšana izmantojot datortomogrāfijas angiogrāfiju (FFRCT) ir metode, kas ļauj neinvazīvi izmeklēt vainagartērijas un diagnosticēt hemodinamiski nozīmīgas stenozes. Metodes un materiāli. PSKUS prospektīvā pētījumā tika iesaistīti 144 pacienti un sadalīti divās grupās. Pētāmajā grupā preoperatīvi tika veikta DTA un iegūtie dati apstrādāti HeartFlow FFRCT. Kontroles grupā preoperatīvi netika veikta DTA. Rezultāti. Pētījumā tika iekļauti 144 pacienti, 67 pētāmajā grupā un 77 kontroles grupā. FFR-CT grupā 62% (n=42) pacienti bija smēķētāji, otrā grupā 80% (n=62), kas bija statistiski atšķirīgi (p=0,017). Hipertensija pētāmajā grupā bija 77% (n=52), bet kontroles grupā 74% (n=57). Dislipidēmija pirmajā grupā kopā bija 47% (n=32) pacientu un 37% (n=28) kontroles grupā. FFR-CT grupā 14% (n=10) un 22% (n=17) pacientu otrā grupā bija cukura diabēts. Antihipertensīvos medikamentus pirmajā grupā lietoja 59% (n=40) pacientu, bet kontroles grupā tie bija 37% (n=28), iegūtie dati bija statistiski atšķirīgi (p=0,008). Statīnus pētāmajā grupā lietoja 49% (n=33) pacientu, bet kontroles grupā 34% (n=26) pacientu. Antikoagulantus vai antiagregantus FFR-CT grupā lietoja 55% (n=37) un 41% (n=31) pacientu kontroles grupā. Pētāmajā grupā 70% (n=47) pacientu FFR bija ≤0,80, 47% (n=32) no šiem pacientiem tika veikta KG, bet tālāk 52% (n=18) tika veikta PKI, 11% (n=4) tika virzīti uz KAŠ un 29% (n=9) pacientu saņēma optimālu medikamentozu terapiju. Kardiovaskulāro notikumu (MACE) skaits statistiski atšķīrās starp abām pētījuma grupām (p=0,011). Secinājumi. Lielākajai daļai PAOS slimnieku bez kardiāliem simptomiem ir hemodinamiski nozīmīgas izmaiņas koronārajos asinsvados (70%) un pacienti nesaņem adekvātu terapiju. Izmantojot FFRCT ir iespējams neinvazīvi atklāt hemodinamiski nozīmīgas stenozes vainagartērijās.Peripheral arterial occlusive disease (PAD) is an atherosclerotic disease which is characterized by occlusion or stenosis of one or more peripheral arteries. Common risk factors for PAD and coronary artery disease (CAD) leads that PAD patients have a higher incidence of CAD and new cardiovascular events. Fractional flow reserve derived from CTA scan (FFRCT) is a method that allows non-invasively examine coronary arteries. A prospective research was conducted PSKUS and 144 patients were divided into two groups. In the study group patients preoperatively received CTA scan and acquired data was processed in HeartFlow FFRCT. Control group did not receive CTA scan before surgery. Major adverse cardiac events (MACE) perioperatively were compared between both groups. Altogether 144 patients were included in the research, 67 in the study group and 77 in the control group. In the FFR-CT group 62% (n=42) patients were smokers and 80% (n=62) patients in the other group there was statistically significant difference (p=0,017). Hypertension was present in 77% (n=52) patients in the study group and in control group 74% (n=57). Dyslipidemia was present together in 47% (n=32) patients in the study group and 37% (n=28) patients in other group. In the research group 59% (n=40) patients were using blood pressure medication but in control group 37% (n=28) patients and acquired data was statistically different (p=0,008). All together 49% (n=33) patients in FFR-CT group were using statins but 34% (n=26) patients in other group. Anticoagulants or antiaggregants were using 55% (n=37) patients in study group and 41% (n=31) patients in control group. In the study group 70% (n=47) patients’ FFR was ≤0,80, and for 47% (n=32) of these patients invasive coronary angiography (ICA) was performed and for 52% (n=18) percutaneous coronary intervention (PCI) was done, 11% (n=4) were guided towards coronary artery bypass grafting (CABG) and for 29% (n=9) patients as best treatment optimal pharmacotherapy was decided. MACE was significantly different between both research groups (p=0,011). Most of PAD patients without CAD symptoms have hemodynamically significant changes in coronary arteries (70%) and these patients do not receive adequate therapy. Using FFRCT it is possible to non-invasively detect significant changes in coronary arteries